Health Management Information Systems

A. Identify a current nursing practice within your healthcare setting that requires change.

HIS in Nursing practice

1. Describe the current nursing practice.

HMISs (Health Management Information Systems) are included among the building blocks vital to strengthening the nation’s health and healthcare system. They may be defined as data collection systems targeted specially at supporting planning, decision-making and management within hospitals smaller healthcare centers and health and healthcare related agencies.

Health information constitutes a central component of an operational health system. An HIS (health information system) offers evidence that supports program- and policy- level decision-making to improve individual and societal health outcomes. But the word “HIS” lacks a well-defined or explicit definition.

The position of nurse informatics (NI) specialist came into being when the health sector recognized the need to have interactions between healthcare professionals and IT experts for the purpose of dealing with patient care issues (Bickford, 2009). NI specialists have a pivotal role to play in the process of care delivery, and constitute a determining factor when selecting, implementing and evaluating healthcare; their efforts foster safe, patient-focused, superior-quality healthcare (Elkind, 2009). According to the ANA (American Nurses Association) (2008), nursing informatics denotes a field which incorporates computer science and nursing science to facilitate information and skills communication and management into nursing practice (p. 1). Another way of defining it is: nursing informatics represents any information technology usage by nursing professionals to improve patient outcomes, facilitate nursing research and education, and manage healthcare centers (Bickford, 2009).

According to several authors, the nurse informatics discipline incorporates two kinds of roles: 1) The specialist responsible for creating, facilitating, testing and implementing novel IT tools and 2) The clinician responsible for utilizing these IT tools. Current healthcare centers integrate the features of mobile labs, electronic prescriptions, tele-health, and e-scheduling of physician appointment, necessitating informatics nurses who help ensure interfacing of computerized solutions with one another (HIMSS, 2011). For completing information-related tasks, informatics nursing staff needs to synchronize and engage in significant technical and clinical data interchange to foster and coordinate safe, efficient care and assure efficient workflow.

Nursing documentation makes up a key healthcare information aspect. Nursing information systems have been devised for ideally using documentation to expand nurses’ care quality-related knowledge. Knowledge has exponentially evolved during the last four decades because of the discovery of novel means of learning. The nursing profession, particularly, has profited from such novel concepts, continually coming up with improved and newer means of achieving patient care improvements. Nursing skills and expertise have an element of personal history which influences their performance of nursing care. Nursing practice standards, nursing theory, and ethical and legal obligations need to be grasped and applied for enhancing nursing care quality.

The EHR (electronic health record) concept has grown to become a key facet of information workflow. IT usage will lead to improvements in care efficiency and quality, thereby bringing about patient outcome improvements. Patient documentation proves crucial when it comes to communication of patient condition and care organization based on individual patients’ unique needs. The profession of nursing has chiefly been guided by patient needs. Based on these needs and relevant environments, a number of theories may be applied to aid personalized care. Individual nurse practice application is founded on medical, nursing, psychological, philosophical, and other theories combined.

2. Discuss why the current nursing practice needs to be changed.

According to a recent report, nearly fifty percent of medical professionals who use Electronic Health Record Systems (EHRS) fail to acquire the necessary patient information to effectively coordinate patient care. Quinn (2015) observes that a DHHS (Department of Health and Human Services)-sponsored research headed by Professor Chun-Ju Hsiao indicated that a mere one-third of healthcare professionals employ EHRs to electronically share patient data. While four in ten professionals do make use of EHRs, they don’t share patient data using these systems (Quinn, 2015).

The entire idea comes down to CCD or continuing care document, with meaningful use being the key. The CCD should stay uniform all through the course of the EHR process (Quinn, 2015). Though compatibility ought to be demonstrated, this rarely happens.

B. Identify the key stakeholders within your healthcare setting who are part of the current nursing practice.

· Nurse informatics (NI) specialists

· The specialist responsible for creating, facilitating, testing and implementing novel IT tools and

· The clinician responsible for utilizing these IT tools

1. Describe the role each identified key stakeholder will play to support the proposed practice change.

· NI specialists

An NI specialist heads evolving technology within the medical domain. Hence, superior communication skills are a must. In an NI work environment, the professional will need to handle and communicate information to customers (i.e., patients), nursing staff, and healthcare providers. They are the link between IT personnel and nursing staff. One objective of information dissemination is enabling individuals to make more sound decisions on the basis of more accurate information.

What are NI specialists expected to do?

An HIMSS (Healthcare Information and Management Systems Society) survey reveals that 57% of participants reported that their chief responsibility was the provision of systems preparation, ongoing user support, and user training; further, 53% dedicated the majority of their efforts towards systems development, involving systems customization or updating, or the creation of a novel homegrown system (HIMSS, 2011). A second area of NI specialist focus is quality control.

A few other responsibilities of NI specialists include:

· Project management

· Systems user education, training and support

· Choosing of the right systems

· Policy writing

· Systems maintenance

· Optimizing systems

Outside of clinics, nursing homes and hospitals, NI specialists also engage in the activities of testing, sales, customer training, and system design.

For the integration and enhancement of EHR and Health Information System (HIS) application within the nursing profession, NI specialists ought to ensure NP (nurse practitioner) participation and determine extant HIS inefficiencies. The specialists ought to endeavor to ascertain areas for improvement for making make the system more practitioner-friendly.

· The specialist responsible for creating, facilitating, testing and implementing novel IT tools

HIT specialists are in charge of the protection and release of protected health-related data in adherence to every regulatory guideline and Libraries for Nursing (LFN) procedure and policy.

HIT specialists are also in charge of repairs and maintenance of IT systems in any healthcare center, including PCs, servers and networks.

What is the role of HIT specialists?

Health information technicians or HIT specialists are in charge of managing and organizing health databases and patient records. With the aid of advanced software, HIT specialists code distinct clinical procedures to serve the purposes of insurance billing and analyses in the future. Additionally, they ensure sensitive health information security. A majority of them are employed in hospitals and physicians’ offices.

HIT specialists’ role involves dealing with the technical elements of patient health data management. Based on their post, they may have to assume the responsibilities of developing, supporting or implementing systems such as EHRs which store patient information. They are expected to be aware of what information is required, how it will be utilized and what location it will be stored.

HIT specialists’ efforts have a significant impact on patient care quality. Further, with their progress up the career ladder, HIT specialists’ collaborations with other members of the patient care team increase, driving improved health outcomes, novel patient care developments, and decreased costs.

HIT specialists are clearly important actors in the area of EHR development, support and implementation. As mentioned earlier, their role has a major influence on healthcare quality. It is vital that they come up with user-friendly systems and interfaces as NPs dislike having to devote a considerable share of their precious time to learning about the system’s functioning. Devising a complicated system may prove detrimental to healthcare organizations. The aim should be increasing patient care and data handling efficiency, instead of increasing complexity. HIT specialists need to first scrutinize a healthcare organization’s needs, followed by coming up with a user-friendly, efficient system for NPs.

· The clinician responsible for utilizing these IT tools

Clinicians ought to readily attempt to work under an HIS. It is usually not easy to accept change. Nursing personnel who are required to engage in the challenging task of learning a new concept or skill and incorporating it into clinical practice may dislike enduring the learning process. A majority of them prefer things to remain as they currently are.

CASs (Complex Adaptive Systems) deal with management practice modification and the ‘revolutionization’ of nursing leadership’s thoughts, problem-solving and behavior. CAS does away with prior beliefs, embracing the attractor (catalysts facilitating spontaneous emergence of novel behaviors) and self-organization concepts which facilitate the emergence of innovation and orderliness (Penprase & Norris, 2005). Emphasizing the fact that the soundest processes commence with personnel (at an entity’s micro level), complexity science provides novel approaches to nursing leadership to effectively navigate the chaotic, complex healthcare management setting.

In several ways, one may consider an HIS to be a CAS that practitioners might be hesitant to incorporate into everyday practice.

C. Create an evidence critique table

1. Identify five sources from scholarly peer-reviewed journals

2. Identify the evidence strength of each chosen source

3. Identify the evidence hierarchy of each chosen source

Full APA citation for at least 5 sources

Evidence Strength (1-7) and Evidence Hierarchy

1. Ajami, S. (2013). Barriers to implement electronic health records (EHRs). Materia Socio Medica, 25(3), 213–215.

4-unsystematic-review study

2. Sittig, D. F. (2014). Electronic health records: Challenges in design and implementation. Boca Raton, FL : Apple Academic Press, Inc. : CRC Press

 7- Expert Opinion

3. Cifuentes, M., Davis, M., Fernald, D., Gunn, R., Dickinson, P., & Cohen, D. J. (2015). Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioural Health and Primary Care. The Journal of the American Board of Family Medicine, 28.

 1-evidence-based strategies

4. Gesulga, J. M., Berjame, A., Moquiala, K. S., Galido, A., & 4th Information Systems International Conference 2017, ISICO 2017. (2017). Barriers to Electronic Health Record System Implementation and Information Systems Resources: A Structured Review. Procedia Computer Science, 124, 544-551.

 7-Expert Opinion

5. Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health records in hospitals: a systematic literature review. BMC Health Services Research, 14(1), 370. 

 5-empirical research

Note:  Evidence Strength will range from level 7 (lowest) to level 1 (highest).  Evidence Hierarchy will reflect the research methodology (Expert Opinion [lowest] to Meta-Analysis [highest]).

D. Develop an evidence summary based on the findings from part C that includes each of the five sources used.

According to Boonstra, Vos and Versluis’s (2014) conclusions, though EHR systems seem to positively impact healthcare institution performance, to implement them is a complicated process. The authors’ systematic review indicates reasons underlying this complexity. The authors have put forward a framework comprising of nineteen interventions which may aid in overcoming typical EHR implementation issues (Boonstra, Versluis & Vos, 2014). The framework may serve as an implementer reference when it comes to the development of efficient EHR implementation approaches for healthcare facilities (Boonstra, Versluis & Vos, 2014).

Cifuentes, Cohen, Dickinson, Fernald, Davis, and Gunn (2015) arrived at the conclusion that integration of primary care and behavioral health adds extra burden to EHRs. Clinicians and vendors may collaborate to come up with EHR products which aid information reporting, documentation, tracking of patients suffering from behavioral and psychological issues over context and time, better registry interoperability and functionality, template-guided documentation for depression and other prevalent behavioral health issues, integrated teams collaborating from shared patient care plans, and other integrated patient care delivery functions (Cifuentes, 2015). Such systems necessitate monetary assistance and partnerships between EHR vendors, healthcare professionals, practice assistants, regulators, workforce trainers and standards setters.

Gesulga and colleagues’ (2017) research findings suggest that EHR systems can improve health service quality chiefly by promoting health information accessibility. Efforts at EHR system adoption within healthcare facilities have largely proved unsuccessful (Gesulga et al., 2017). The authors conducted a literature review for identifying obstacles to EHR system implementation. Identification of these obstacles will herald the assessment of organizational preparedness to institute this sort of system. The structured followed PRISMA guidelines. Obstacles determined were classified into information system resources by the researchers (Gesulga et al., 2017). According to the review, the chief obstacles were: procedure resource (inadequate policy and admin support and ROI (return on investment) related concerns) and people resource (lack of skill and user opposition). The author identified the need for additional research for performing a more in-depth analysis of obstacles and understanding how to tackle them (Gesulga et al., 2017).

Ajami (2013) found that in spite of EHRs’ prospective advantages, their implementation is linked to a number of restrictions and obstacles, including; cost constraints, standardization limits, technical limitations, institutional limitations and attitudinal constraints (i.e., user behavior) (Ajami, 2013). Numerous research works suggest that opposition to change constitutes the most salient limitation to EHR adoption (Ajami, 2013).

Sittig (2014) summarized EHR system design and adoption related challenges, besides best practices identified in the last many years. The author explores concerns associated with EHR utilization, and puts forwards 8 examples of correct EHR usage (Sittig, 2014). Moreover, the author explores the multifaceted strategic planning accompanying systemic institutional change linked to EHR programs, highlighting important lessons learned with regard to health information (this includes risk management and technological errors) (Sittig, 2014).

E. Recommend a specific best practice based on the evidence summary developed in part D.

Cifuentes and coworkers (2015) arrived at the conclusion that integration of primary care and behavioral health adds extra burden to EHRs. Clinicians and vendors may collaborate to come up with EHR products which aid information reporting, documentation, tracking of patients suffering from behavioral and psychological issues over context and time, better registry interoperability and functionality, template-guided documentation for depression and other prevalent behavioral health issues, integrated teams collaborating from shared patient care plans, and other integrated patient care delivery functions (Cifuentes, 2015). Such systems necessitate monetary assistance and partnerships between EHR vendors, healthcare professionals, practice assistants, regulators, workforce trainers and standards setters.

Cifuentes’ (2015) research involved eight primary care facilities utilizing one EHR and two different EHRs (for recording primary care data and behavioral health separately) utilized by three practices. Commonly-experienced EHR-related challenges included: 1) documenting and tracking of relevant physical and behavioral health data, 2) information interchange using devises such as tablets, and 3) supporting care coordination and communication between integrated care units (Cifuentes, 2015). Workarounds were developed as a response to the following challenges: duplicate information entry and double documentation, document scanning and transport, separate tracking system usage, and dependency on practitioner or patient recall for EHR data that wasn’t accessible. With clinics gaining experience through integration, they started moving beyond workarounds and adopting more permanent health IT solutions including personalized EHR templates, unified EHRs and EHR upgrades (Cifuentes, 2015).

F. Identify a practice change model that is appropriate to apply to the proposed practice change.

The solution to EHR and HIS adoption is clinician and vendor collaboration to come up with powerful, highly efficient EHR products which aid information reporting, documentation, tracking of patients suffering from behavioral and psychological issues over context and time, better registry interoperability and functionality, template-guided documentation for depression and other prevalent behavioral health issues, integrated teams collaborating from shared patient care plans, and other integrated patient care delivery functions (Cifuentes, 2015).

1. Justify why you chose the practice change model.

Over time, the technology-based approach has proven its efficacy in reducing human error in sectors such as banking and aviation. HIS might facilitate improvements in medical quality and safety by integrating decision-making tools and knowledge into actual clinical practice. This will subsequently decrease omission errors that typically leave knowledge gaps and inefficiencies, which adversely impact knowledge synthesis and application within patient care settings (Shekelle, Morton & Keeler, 2006). HIS integration into expansive systems may help improve healthcare decision-making and the effective use of diagnostic examinations and therapeutic agents. IT adoption has grown to become an essential component of improved access to basic, important information, automation, and decreased labor-intensiveness and human error. Thus, it would be sensible for the health sector to utilize means to enhance EHR and build more robust HIS platforms to decrease medical errors and improve efficacy. This serves to further help decrease preventable, unnecessary health failure.